BP and LV Remodeling in American-Style Football Players

Study Questions:

Among American-style football players, are there relationships between acquired left ventricular (LV) hypertrophy and echocardiographic measures of LV systolic function?


This was a prospective, longitudinal cohort study evaluating National Collegiate Athletic Association (NCAA) Division I first-year football athletes from Harvard University, stratified by field position (linemen: n = 30; non-linemen, n = 57) before and after a single competitive season. Transthoracic echocardiography was used to assess LV systolic function using complementary parameters of global longitudinal strain (GLS; using two-dimensional speckle-tracking) and ejection fraction (EF; two-dimensional biplane imaging).


American-style football participation was associated with field position-specific increases in systolic blood pressure (SBP) (a change [∆] in SBP of 10 ± 8 mm Hg in linemen vs. a ∆ in SBP of 3 ± 7 mm Hg in non-linemen; p < 0.001) and an overall increase in incident LV hypertrophy (preseason prevalence = 8% vs. post-season = 25%, p < 0.05). Linemen who developed LV hypertrophy had concentric geometry (9 of 11 [82%]) with decreased GLS (∆ = –1.1%; p < 0.001), whereas non-linemen demonstrated eccentric LV hypertrophy (8 of 10 [80%]) with increased GLS (∆ = +1.4%; p < 0.001). In contrast, LVEF in the total cohort, stratified by field position, was not significantly affected by football participation. Among the total cohort, lineman field position, post-season weight, SBP, average LV wall thickness, and relative wall thickness were all independent predictors of post-season GLS.


American-style football participation at a lineman field position may lead to a form of sport-related myocardial remodeling that is pathologic rather than adaptive. The authors concluded that future study will be required to determine if targeted efforts to control BP, minimize weight gain, and include an element of aerobic conditioning in this subset of athletes may attenuate this process and translate into tangible downstream health benefits.


Harvard football athletes appeared to be at risk for developing hypertension and LV hypertrophy during the course of their initial NCAA season, with specific changes related to lineman vs. nonlineman football position. Although LVEF did not change as a result of training, global longitudinal strain analysis suggested unfavorable changes in LV systolic function only among linemen. Impaired global longitudinal strain is associated with adverse outcomes in other populations; however, clinical endpoints were not addressed in this study.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Sports and Exercise Cardiology, Acute Heart Failure, Echocardiography/Ultrasound, Exercise, Hypertension, Sports and Exercise and Imaging

Keywords: Athletes, Blood Pressure, Blood Pressure Determination, Diagnostic Imaging, Echocardiography, Exercise, Football, Heart Failure, Hypertension, Hypertrophy, Left Ventricular, Primary Prevention, Stroke Volume, Systole, Ventricular Function, Left, Weight Gain

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